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. 2022 Nov 2;61(11):4286-4296.
doi: 10.1093/rheumatology/keac081.

Do patient-reported measures of disease activity in rheumatoid arthritis vary between countries? Results from a Nordic collaboration

Bénédicte Delcoigne  1 , Sella Aarrestad Provan  2 , Hilde Berner Hammer  2   3 , Daniela Di Giuseppe  1 , Thomas Frisell  1 , Bente Glintborg  4   5 , Gerdur Grondal  6 , Bjorn Gudbjornsson  6 , Merete Lund Hetland  4   5 , Brigitte Michelsen  2   7 , Dan Nordström  8   9 , Heikki Relas  8 , Johan Askling  1
Affiliations

Do patient-reported measures of disease activity in rheumatoid arthritis vary between countries? Results from a Nordic collaboration

Bénédicte Delcoigne et al. Rheumatology (Oxford). .

Erratum in

Abstract

Objectives: To investigate whether patient-reported outcomes vary across countries and are influenced by cultural/contextual factors. Specifically, we aimed to assess inter-country differences in tender joint count (TJC), pain and patient's global health assessment (PGA), and their impact on disease activity (DAS28-CRP) in RA patients from five Nordic countries.

Methods: We collected data (baseline, 3- and 12-months) from rheumatology registers in the five countries comprising RA patients starting a first ever MTX or a first ever TNF inhibitor (TNFi). In order to assess the role of context (=country), we separately modelled TJC, pain and PGA as functions of objective variables (CRP, swollen joint count, age, sex, calendar period and disease duration) with linear models. Analyses were performed at each time point and for both treatments. We further assessed the impact of inter-country differences on DAS28-CRP.

Results: A total of 27 645 RA patients started MTX and 19 733 started a TNFi. Crude inter-country differences at MTX start amounted to up to 4 points (28 points scale) for TJC, 10 and 27 points (0-100 scale) for pain and PGA, respectively. Corresponding numbers at TNFi start were 3 (TJC), 27 (pain) and 24 (PGA) points. All differences were reduced at 3- and 12-months, and attenuated when adjusting for the objective variables. The variation in predicted DAS28-CRP across countries amounted to <0.5 units.

Conclusions: Inter-country differences in TJC, pain and PGA are greater than expected based on differences in objective measures, but have a small clinical impact on DAS28-CRP across countries.

Keywords: disease activity; inter-country comparison; pain; patient-reported outcome (PRO); rheumatoid arthritis.

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Figures

<sc>Fig.</sc> 1
Fig. 1
Mean predicted values of baseline, 3 and 12 months DAS28-CRP for each country population initiating a first ever MTX treatment The four solid shapes are the mean predicted DAS28-CRP values for patients in their own country. Similar shapes (i.e. displayed horizontally, not solid), show the means of the DAS28-CRP values that were predicted for the population of a given country, should this population be assessed in another country. Denmark was the country where the means of the predicted values at baseline and 3 months were the highest, as for any given shape, the highest one was in Denmark.
<sc>Fig.</sc> 2
Fig. 2
Mean predicted values of baseline, 3 and 12 months DAS28-CRP for each country population initiating a first ever TNFi treatment The five solid shapes are the mean predicted DAS28-CRP values for the patients in their own country. Similar shapes (i.e. displayed horizontally, not solid), show the means of the DAS28-CRP values that were predicted for a given country’s population, should this population be assessed in another country. At baseline, Denmark and Iceland were the countries where the means of the predicted values were the highest, as for any given shape, the two highest ones were in Denmark and Iceland.
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References

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